EUTHANASIA, term denoting "the action of inducing gentle and easy death," first used by the British moral historian W.E.H. Lecky in 1869. Among advocates of this measure to terminate the life of sufferers from incurable or painful disease are many earlier philosophers, Christian as well as pagan, including Plato in his Republic (3:405ff.) and Sir Thomas More in his Utopia (2:7). The precise Hebrew equivalent for euthanasia, mitah yafah ("pleasant death"), occurs several times in the Talmud, though always in connection with the duty to reduce to a minimum the anguish of capital criminals before their execution (e.g., Sanh. 45a), and never in the sense of deliberately hastening the end of persons dying from natural causes. In the Jewish view, life being of infinite worth, any fraction of it is of equally infinite value, and the relief from suffering cannot be purchased at the cost of life itself, whatever other concessions Jewish law may make or urge for the mitigation of pain. Hence, "a patient on his deathbed is considered as a living person in every respect … and it is forbidden to cause him to die quickly … or to move him from his place (lest this hasten his death);… and whoever closes his eyes with the onset of death is regarded as shedding blood" (Sh. Ar., YD 339:1 and gloss). Indeed, killing any innocent person, "whether he is healthy or about to die from natural causes," is legally codified as murder (Maim. Yad, Roẓe'aḥ 2:7). Some recent rabbinical responsa, however, are inclined to sanction the cessation of "heroic" methods to prolong a lingering life without hope of recovery. The withdrawal of treatment under such circumstances might be justified on the basis of the permission to remove from a dying person an extraneous impediment, such as "a clattering noise or salt on his tongue, delaying the departure of his soul" (Sh. Ar., loc. cit., gloss).

The otherwise uncompromising opposition to euthanasia no doubt springs from the life-affirming attitude of Judaism in which, nationally as well as individually, life in misery is to be preferred to death with glory or dignity, a sentiment which stirred the Psalmist to exclaim gratefully: "The Lord hath chastened me sore; but He hath not given me over unto death" (Ps. 118:18). For the same reason, martyrdom is permitted only in the most exceptional circumstances; to lay down one's life, even for the fulfillment of divine laws, when such sacrifice is not required by law, is regarded as a mortal offense (Maim. Yad, Yesodei ha-Torah 5:4).

[Immanuel Jakobovits]

In Nazi Germany

Euthanasia was also a euphemism used by the Nazi regime for the murder of the disabled, a group of human beings de-famed as "life unworthy of life." Although Adolf Hitler and his associates talked about "mercy death" their aim was not to shorten the lives of persons with painful terminal diseases but to kill those they considered inferior, who could otherwise have lived for many years.

The belief that mentally and physically disabled human beings should be excluded from a nation's gene pool was a staple argument of the international eugenic movement, in Germany known as racial hygiene, and had led to widespread sterilization of the disabled in various countries, including the United States. The Nazis incorporated the goals of the eugenicists into their racial world view, and on July 14, 1933, only four and a half months after Hitler became chancellor, the German government enacted the Law for the Prevention of Offspring with Hereditary Diseases, the so-called sterilization law mandating the compulsory sterilization of the disabled. This law led to the sterilization of three to four hundred thousand disabled German nationals, representing about 0.5 percent of the German population.

The attack on patients with disabilities in state hospitals and nursing homes during the 1930s had involved sterilization and a reduced standard of care. But this was only the beginning. In 1935 Adolf Hitler told Gerhard Wagner, the Reich physicians' leader, that once war began he would implement the killing of the disabled. As Germany unleashed World War II and Nazi policy became more radical, the regime crossed the line separating traditional eugenic policies from killing operations. Although this radical decision had been initiated by the political leadership, the scientific and medical community did not oppose it, because the idea had circulated since at least 1920, the year the jurist Karl Binding and the psychiatrist Alfred Hoche published The Authorization for the Destruction of Life Unworthy of Life.

The first Nazi killing operation was directed against institutionalized disabled patients. It started with the killing of infants and young children born with mental or physical disabilities. Hitler appointed Dr. Karl Brandt, his escorting physician, and Philipp Bouhler, who headed the Chancellery of the Fuehrer (Kanzlei des Fuehrers, or KdF), to direct the killing operation, and they in turn designated Viktor Brack, chief of Office II in the KdF, as the person to implement the Fuehrer's order. The so-called children's euthanasia was top-secret and was carried out in various hospitals. There the children were placed in so-called special children's wards; they were killed with an overdose of common barbiturates, and sometimes also through starvation diets.

In September 1939, the killing operation was expanded to include adults. Hitler first appointed Leonardo Conti, state secretary for health in the Reich Ministry of Interior, to direct adult euthanasia, telling him in the presence of Hans Heinrich Lammers and Martin Bormann "that he considered it appropriate that life unfit for living of severely insane patients should be ended by intervention that would result in death." Conti accepted the assignment, but he did not remain in charge long; within a few weeks, Hitler replaced him, turning once again to Brandt and Bouhler as his plenipotentiaries, so that Brack and the KdF could administer adult euthanasia alongside that for children. To avoid implicating the Chancellery, the staff administering the euthanasia killings moved from the KdF into a confiscated Jewish villa at Tiergarten Street number 4 and euthanasia was thus soon known as Operation T4, or simply as T4.

The method used to kill the children could not be used to kill the far larger number of adults. To accomplish its task, T4 therefore constructed killing centers, including gas chambers and crematoria, and developed a killing technique to select, transport, and "process" the victims. And always the killers robbed the corpses of their victims, taking gold teeth and bridge work to enrich the state as well as internal organs to enrich "scientific research." For this purpose, T4 established six killing centers – Brandenburg, Grafeneck, Hartheim, Sonnenstein, Bernburg, and Hadamar – but only four were ever operational at the same time. To hide the killings, T4 used subterfuge to fool the relatives; the killing centers camouflaged as hospitals wrote letters of condolence and issued fraudulent death certificates.

In their 1920 book, Binding and Hoche had argued that euthanasia could only function if the act of this kind of mercy death would be decriminalized, so that physicians would not have to fear prosecution under the murder statute, paragraph 212 of the German penal code, which remained in force throughout the Nazi period. Since Hitler absolutely refused to consider promulgating a euthanasia law, the KdF decided to ask Hitler for written orders, so that they could convince physicians to collaborate. In October 1939, Hitler finally signed a document, more an authorization than an order, that had been prepared by the KdF. But to emphasize that war would not only alter the international status of the Reich but also herald "domestic purification," he predated it to September 1, 1939, the day World War II began. Prepared on Hitler's personal stationery, as if mass murder was his "private affair," but never promulgated or published in any legal gazette, this authorization did not actually have the force of law, but served, nevertheless, as the "legal" basis for the killing operation.

The imposed secrecy did not prevent news of the murder of the disabled to reach the general population. The unrest of victims' relatives posed a danger to the regime, and in August 1941 Hitler therefore ordered a stop to the gassing of the disabled. This order did not, however, end the killing of the disabled; only their gassing in killing centers stopped. Children's euthanasia continued without interruption; adults were murdered in regular hospitals spread throughout the Reich. The T4 killing centers also continued to operate for several years; they were used to kill concentration camp inmates under a killing enterprise known as Operation 14 f13. The Austrian killing center Hartheim near Linz continued in operation until late in 1944 for the killings under 14f13 and later for the murder of prisoners from the nearby Mauthausen concentration camp. Furthermore, a selected number of T4 male staff members were dispatched to Lublin to operate the killing centers of Operation Reinhard: Belzec, Sobibor, and Treblinka. One of those was the Austrian physician Irmfried Eberl, medical director of the T4 killing centers in Brandenburg and Bernburg, who served as the first commandant of Treblinka.

After the war, the perpetrators argued that Jews were never killed in Operation T4, since they did not "deserve" mercy death, and this was believed at the Nuremberg and later trials. But this was not true. Jewish institutionalized disabled patients were included alongside non-Jewish victims from the beginning. In the spring of 1940, however, a decision was made on the highest level to kill Jewish patients as a group. They were concentrated in a number of central institutions, and killed in the closest killing center. But for the Jews there were no letters of condolence; the Jews were supposed to disappear without a trace. In the end, however, T4 did issue fraudulent death certificates long after the victims had been killed; this permitted T4 to extort money for weeks, even months, for upkeep of the already murdered Jewish patients. To accomplish this, T4 claimed the patients had been deported to a non-existent hospital in Cholm in Poland, and issued fraudulent death certificates with that nonexistent address.